Covid and Hospitals: How are things now?

MunoRN, RN · Dec 22, 2021

We're over 300 licensed beds, inpatient occupancy has been at 320 plus. Our ICU is about 50 beds, which for a long time was 10-20 beds for Covid, it's currently 30 Covid beds, mostly long term vent/CRRT, although many of which are past 20 days and could move out into the regular ICU but there's not many beds left there either.

What's become really apparent at this point is that once you get ICU-level sick with Covid you aren't going to get better. Best case scenario you die, worst case scenario you don't. Of the few acutely ill "survivors" only one had some small amount of awareness of the world around him, and if anything I think that makes his situation worse than the others.

Of the ones that managed to avoid vents and CRRT (and ECMO) they are still in and out of the hospital due to end-stage lung function which just exacerbates our bed-availability issues.

Basically, it sucks and it's only going to get worse.

ladycody, BSN, RN · Dec 22, 2021

4 hours ago, MunoRN said:

What's become really apparent at this point is that once you get ICU-level sick with Covid you aren't going to get better.

Just wanted to offer a little bit of hope in that I've seen two come off the vent and be mostly OK. One wound up with an amp... and I've no idea what other long term issues they'll be dealing with...but both were fully conversant with decent mobility. They certainly weren't what they were before covid...but they didn't make you wonder if death might have been a blessing...which is how it feels for so many. Just know there can be a rare decent recovery. It helps to have hope I think.

CrunchRN, ADN, RN · Dec 22, 2021

Munro - that is pretty much how I feel. If you get ICU level sick the aftermath of survival may be worse than death.

I wonder if Omicron will displace Delta and be less severe? That is what I am hoping for. Displace is no doubt the wrong term to use, but you get the idea.

Guest219794 · Dec 22, 2021

3 hours ago, CrunchRN said:

Munro - that is pretty much how I feel. If you get ICU level sick the aftermath of survival may be worse than death.

I wonder if Omicron will displace Delta and be less severe? That is what I am hoping for. Displace is no doubt the wrong term to use, but you get the idea.

Best case scenario is that Omicron is less severe despite being more transmissible. While that bodes well for the individual who gets Covid, it can impact the system even more.

If the virus results in 20% fewer hospitalizations per 1000 infections, but the infection rate doubles, that is a huge increase in numbers.

Obviously those numbers are made up, but you get the idea.

MunoRN, RN · Dec 22, 2021

9 hours ago, ladycody said:

Just wanted to offer a little bit of hope in that I've seen two come off the vent and be mostly OK. One wound up with an amp... and I've no idea what other long term issues they'll be dealing with...but both were fully conversant with decent mobility. They certainly weren't what they were before covid...but they didn't make you wonder if death might have been a blessing...which is how it feels for so many. Just know there can be a rare decent recovery. It helps to have hope I think.

We've had a number of patients come off vents and eventually walk out of the hospital, but that was early on when "early intubation" was the rule. It turns out that was probably doing more harm than good.

For the most part these days it seems people who get that critically ill either expire eventually or just stall out and just stay chronically ill.

macawake, MSN · Dec 22, 2021

11 hours ago, CrunchRN said:

I wonder if Omicron will displace Delta and be less severe? That is what I am hoping for. Displace is no doubt the wrong term to use, but you get the idea.

I think that Omicron already is the dominant variant in the U.S.? It definitely is in several European countries. It appears to transmit very easily and became the dominant strain in in these countries almost in a matters of days.

There are recent reports from South Africa and England that it might cause less severe disease but more reinfections than Delta. And I just found this from Scotland. It’s all pre-print and not peer-reviewed. It’s still early days and much of the data seems to involve relatively young people. Will it look the same as more elderly folks become infected? Will these early results be confirmed by more data? We simply don’t know yet. It’s been less than a month since Omicron was designated a variant of concern and it’s spreading like a wildfire. Anyway, here’s the data from Scotland.

Abstract:

https://www.research.ED.ac.uk/en/publications/severity-of-omicron-variant-of-concern-and-vaccine-effectiveness-

Page 10 under ”Discussion” lists several limitations.

https://www.pure.ED.ac.uk/ws/portalfiles/portal/245818096/Severity_of_Omicron_variant_of_concern_and_vaccine_effectiveness_against_symptomatic_disease.pdf

CrunchRN, ADN, RN · Dec 23, 2021

And, this morning I read the peak seems to be falling off sharply in Africa already. Wow. Of course, who knows what will happen here.

I read so many articles while on the eliptical I forget which came from where, but one meta analysis said that 90% or more of the people they looked at tested positive without any symptoms. So many reports from such short term experience it is hard to really source them all in a logical way.

macawake, MSN · Dec 23, 2021

3 hours ago, CrunchRN said:

And, this morning I read the peak seems to be falling off sharply in Africa already. Wow. Of course, who knows what will happen here.

I think it’s simply too early to be certain about much of anything regarding Omicron other than that it’s highly transmissible. I share your hope that it will turn out to be milder. We’ll just have to wait and see.

This might interest you (or someone else on the thread).

https://www.theguardian.com/world/2021/dec/14/south-africa-previous-infections-may-explain-omicron-hospitalisation-rate

turtlesRcool · Dec 23, 2021

23 hours ago, macawake said:

I think that Omicron already is the dominant variant in the U.S.? It definitely is in several European countries. It appears to transmit very easily and became the dominant strain in in these countries almost in a matters of days.

I think the dominant variety is location dependent. We're seeing the northeast getting battered by Omicron. Fortunately New England has some of the best vaccination rates in the country, so the increased positivity rates aren't completely overwhelming us. But the hospitals are definitely full, and I've been getting texts for EVERY.SINGLE.SHIFT for two weeks now offering double incentive pay to pick up. People boarding in the ED because no inpatient beds. You get the picture. Home tests are sold out everywhere, and crazy lines to try to get rapid tests at clinics.

macawake, MSN · Dec 23, 2021

37 minutes ago, turtlesRcool said:

I think the dominant variety is location dependent. We're seeing the northeast getting battered by Omicron. Fortunately New England has some of the best vaccination rates in the country, so the increased positivity rates aren't completely overwhelming us. But the hospitals are definitely full, and I've been getting texts for EVERY.SINGLE.SHIFT for two weeks now offering double incentive pay to pick up. People boarding in the ED because no inpatient beds. You get the picture. Home tests are sold out everywhere, and crazy lines to try to get rapid tests at clinics.

I’ll link the numbers I was thinking of when I responded to CrunchRN’s post. The CDC reported a couple of days back that slightly over 73% of all new cases in the US are now Omicron. That’s up from single digits % the previous week. It has taken over but I am sure that it’s not exactly 73% across the entire country (your country is huge, almost a continent ?), so probably not evenly distributed. But give it another week. This variant is fast!

About 40 seconds in she mentions the percentage of Omicron cases.

https://www.beckershospitalreview.com/public-health/CDC-omicron-now-accounts-for-73-of-us-cases-1st-us-death-reported.html

https://www.theguardian.com/world/2021/dec/20/us-covid-omicron-coronavirus

I hope the situation doesn’t get any worse at your hospital (and mine and everyone else’s of course). It’s hard to predict exactly what impact Omicron will have but I think it’s safe to say that we’re all sick and tired of hospital floors packed to the rafters with Covid patients ☹️

Take care ??

JBMmom, MSN, NP · Dec 24, 2021

On 12/22/2021 at 12:23 AM, MunoRN said:

What's become really apparent at this point is that once you get ICU-level sick with Covid you aren't going to get better.

Sadly this is nearly 100% our experience. I did just post recently that we had one (vaccinated) gentleman come off the vent without a trach and he's now doing much better on the med-gen floor. That's one since October. Everyone else on the vent has died.

One hard part lately is listening to some of these providers talk with family members and give them unrealistic hope for a full recovery. Not that it's new, I think we've all been listening to doctors for years and wanted to scream as they say the patient is "doing better", when those of us providing the 24/7 care see the reality of their situation. For example, our intensivists work one week rotations, on Monday morning I reported off to him about one of my patient's that was clearly going to die. He asked me why we weren't tube feeding (high residuals, emesis, etc). so we started reglan to stimulate gut motility (meanwhile he's requiring daily dialysis, has been anuric for two weeks, has persistent fevers greater than 104 degrees, etc). Yesterday we started tube feeds! He told the wife we were going to feed him which will help with his strength (?!). This morning I sent him to the morgue. The look of hope on her face the past few days was heartbreaking to those of us caring for him because we all just wanted to shake the doctor and scream. I'm not saying hope isn't a good thing, but blindly unrealistic updates from doctors are the opposite of helpful and it's just another aspect of this whole pandemic that's been crushing to watch.

Guest219794 · Dec 24, 2021

49 minutes ago, turtlesRcool said:

I think the dominant variety is location dependent. We're seeing the northeast getting battered by Omicron. Fortunately New England has some of the best vaccination rates in the country, so the increased positivity rates aren't completely overwhelming us. But the hospitals are definitely full, and I've been getting texts for EVERY.SINGLE.SHIFT for two weeks now offering double incentive pay to pick up. People boarding in the ED because no inpatient beds. You get the picture. Home tests are sold out everywhere, and crazy lines to try to get rapid tests at clinics.

Where I work, people are not getting good care as a result of the strain Covid is putting on the system. This has nothing to do with the mortality rate. All of the 40-60 year old unvaccinated walkie talkies with SPO2 < 90% are adding to the crisis. From where I sit- an ER bogged down with admits, it is not a question of how sick. If they are sick enough to get a bed, they muck the system up even more. I do my best, but these admits stuck in the ER are getting poor care. I am one of those providing it.

I think that when you look at a region, or a state, that really only tells part of the story. Many states are divided politically, with a direct correlation to Covid. Southern and coastal Maine are vastly different areas politically and economically from the rest of the state.